00:02
Hi! I’m Jessica Spellman. This is the Ws
of using restraints, the who, what, when,and how to use restraints. After taking this
course, you will be able to define a restraintand be able to give examples. Understand what is
needed to initiate, intervene, and discontinuerestraint orders. Explain the nurses’ role
and caring for a patient with a restraint.
00:28
Recall the proper legal documentation that
must be present when caring for a patientwith restraints. So let’s start with the
definition of a restraint. A restraint isa means of unreasonably limiting freedom of
movement. And this can be done in severalways. There are four types of restraints.
The first is physical, mechanical, chemical,and using seclusion. A physical restraint.
A physical restraint is when you’re holdinga patient in a manner in which his or her
movement is restricted. An example would bea patient is confused and attempting to hit
you with their hand. So you hold their handand/or wrist to prevent being hit. This is an
example of a physical restraint. A mechanicalrestraint. When we limit a patient’s movement
but we use a device to do so. So an exampleof that would be applying wrist restraints to
prevent a patient from extubating themselves.
01:33
A chemical restraint. This is when we use
a medication for the purpose of restraintinstead of treatment. So an example would
be using a medication to sedate a patientso they cannot pull out tubes or lines or
if they’re combative. And then the use ofseclusion is when we place the patient alone
in the room so they cannot communicate orsee any staff or patients. As long as the
patient believes they cannot get out of theroom, it is considered seclusion. It’s important
that in a licensed operator or contracteddepartment of mental health facility, that
a mechanically strained patient may not beplaced in seclusion. So those are two types
of restraints that cannot be used together.
02:19
Otherwise, we can combine these and do physical
restraints and chemical restraints, but seclusionis not one that can be used with physical
restraints. I just wanted to make animportant point. So when can restraints be
used? The appropriate use of restraints isto prevent harm for patients and to prevent
imminent violence to others.
02:48
Inappropriate ways that we try to avoid using restraints
for, are to punish or attempt to modify patientbehavior. For example, saying, “If you continue
to do X, Y, and Z, I’m going to have torestrain you.” We don’t want to threaten
patients with the use of restraints. We don’twant to use restraints for staff convenience.
And we don’t want to use restraints on asneeded or PRN basis. Restraints should be
considered only after all other less restrictivealternatives have been determined to be ineffective.
So once we determine that somebody needs restraints,who may order the restraints? They do require
an order by a physician or another independentpractitioner. However, nurses may go ahead
and initiate the use of restraints if thepatient is in danger of harming themselves or
others. After the initiation, it is appropriatethat within an hour that a physician must
evaluate the patient in order to determinewhether the restraints are continued to be
necessary. Verbal orders cannot take the placeof the physician evaluating the patient. It
must be determined to be the most appropriatemethod of restraining the patient. It may
be issued over the phone by a physician thathas previously examined the patient, but that
must be given directly to a registered nurse.
04:15
So if the patient has not been seen by that
physician, that physician cannot be calledin or called over the phone to initiate a
verbal order for restraints. Medicationthe physician ordered must have been given
previously to the patient. We cannot initiatenew medication orders over the phone. And
then the treating physician must be contactedas soon as possible if he or she did not order
the restraint. So just to clarify this, ifthere is an on-call physician on night shift
that comes and sees the patient and ordersthe initial order for restraints, the treating
physician or attending physician still needsto be contacted about the restraint order.
So, how long can we use restraints? Initialrestraint orders are valid for three hours. At
three hours, the nurse or physician assistantor authorized physician representative may
continue the order if the rationale for theuse of the restraints still exists. At six
hours, the physician must examine the patientand determine if the order should be renewed.
The maximum amount of time restraints or seclusionmay be used is eight hours and a 24-hour period.
If the physician determines that they shouldbe used longer than that, a new order must
be written every 24 hours. So, why shouldrestraints be discontinued? When the emergency
no longer exists, the patient must be releasedfrom the restraints or the seclusion. Second,
the patient needs to be calm. And third, thepatient does not present a threat to himself
or herself or the staff. So as nurses, whatdo you need to document when you have a patient
in restraints? The first thing you want todocument is the situation that initiated the use
of the restraints. You also want to documentwho was contacted and what orders you received
from that individual. You want to documentthe time the restraints were initiated, how the
nurse is maintaining safety for the restrainedpatient, and any other interventions the nurse
is performing to calm the patient.
06:35
Ongoing and frequent assessments are part of the documentation
that nurses need to record. What is importantto include, specifically is circulation checks
to the extremities. We’re looking for apulse, the color or the pallor, the polar
whether it’s cold or warm. The paresthesiawhether it’s numb or have normal sensation.
Paralysis, can they move their extremities,and if there’s pain. These are called the
six Ps of the circulation checks- they're pulse,pallor, polar, paresthesia, paralysis, and
pain. How can nurses protect patients thatare in restraints? The patient must be fully
clothed to maintain their dignity. And theymust be offered a urinal or bedpan, or access
to the bathroom. In addition, they reallyneed to be observed continually or at least
every 30 minutes in order to determine ifthe restraint or seclusion still needs to
be used. They also need to be informed ofthe rationale for the restraints as well as
provided interventions to assist with maintainingtheir emotional anxiety. Let’s review what
we’ve learned about restraints.
07:54
We’ve learned what they are. There are several types
of restraints- physical, mechanical, chemical,and seclusion. Who may use restraints? Nurses
may initiate the order, but the physicianmust evaluate the patient within an hour of
initiation. How long do we use restraintsfor? The least amount of time possible. How
do we document the use of restraints? We documentthe time the restraint was initiated, the physician
that was contacted and orders received,how the nurse is maintaining patient safety
while in restraints, and we need to performcirculation checks; the pulse, pallor, polar,
paresthesia, paralysis, and pain of the extremitiesthat are being restrained. This has been the use
of using restraints, and I’m Jessica Spellman. Thanks.

About the Lecture

The lecture Restraints and Use of Safety Devices by Jessica Reuter is from the course Safe and Effective Care Environment. It contains the following chapters:

The W's of Using Restraints

Who may order restraints?

What should be documented?

Author of lecture Restraints and Use of Safety Devices

Jessica Reuter

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skillful teaching

By Neuer N. on 23. September 2017 for Restraints and Use of Safety Devices

the lecture was good almost contain required criteria of knowledge and is delivered so well.

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skillful teaching

By Neuer N. on 23. September 2017 for Restraints and Use of Safety Devices

the lecture was good almost contain required criteria of knowledge and is delivered so well.

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